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Shariq S, Cardoso Pinto AM, Budhathoki SS, Miller M, Cro S. Barriers and facilitators to the recruitment of disabled people to clinical trials: a scoping review. Trials 2023; 24:171. [PMID: 36890505 PMCID: PMC9994780 DOI: 10.1186/s13063-023-07142-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 02/07/2023] [Indexed: 03/10/2023] Open
Abstract
INTRODUCTION Underrepresentation of disabled groups in clinical trials results in an inadequate evidence base for their clinical care, which drives health inequalities. This study aims to review and map the potential barriers and facilitators to the recruitment of disabled people in clinical trials to identify knowledge gaps and areas for further extensive research. The review addresses the question: 'What are the barriers and facilitators to recruitment of disabled people to clinical trials?'. METHODS The Joanna Briggs Institute (JBI) Scoping review guidelines were followed to complete the current scoping review. MEDLINE and EMBASE databases were searched via Ovid. The literature search was guided by a combination of four key concepts from the research question: (1) disabled populations, (2) patient recruitment, (3) barriers and facilitators, and (4) clinical trials. Papers discussing barriers and facilitators of all types were included. Papers that did not have at least one disabled group as their population were excluded. Data on study characteristics and identified barriers and facilitators were extracted. Identified barriers and facilitators were then synthesised according to common themes. RESULTS The review included 56 eligible papers. The evidence on barriers and facilitators was largely sourced from Short Communications from Researcher Perspectives (N = 22) and Primary Quantitative Research (N = 17). Carer perspectives were rarely represented in articles. The most common disability types for the population of interest in the literature were neurological and psychiatric disabilities. A total of five emergent themes were determined across the barriers and facilitators. These were as follows: risk vs benefit assessment, design and management of recruitment protocol, balancing internal and external validity considerations, consent and ethics, and systemic factors. CONCLUSIONS Both barriers and facilitators were often highly specific to disability type and context. Assumptions should be minimised, and study design should prioritise principles of co-design and be informed by a data-driven assessment of needs for the study population. Person-centred approaches to consent that empower disabled people to exercise their right to choose should be adopted in inclusive practice. Implementing these recommendations stands to improve inclusive practices in clinical trial research, serving to produce a well-rounded and comprehensive evidence base.
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Affiliation(s)
- Sameed Shariq
- School of Public Health, Imperial College London, London, UK
| | | | | | - Marie Miller
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | - Suzie Cro
- Imperial Clinical Trials Unit, Imperial College London, London, UK
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Nelson LA, Williamson SE, LeStourgeon LM, Mayberry LS. Retaining diverse adults with diabetes in a long-term trial: Strategies, successes, and lessons learned. Contemp Clin Trials 2021; 105:106388. [PMID: 33812991 DOI: 10.1016/j.cct.2021.106388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/25/2021] [Accepted: 03/28/2021] [Indexed: 11/30/2022]
Abstract
Background Retention can be difficult in longitudinal trials, especially among minoritized groups and individuals with low socioeconomic status (SES) who may experience more barriers to research participation. Organized retention strategies may help; however, limited research has reported on this in detail. Methods We employed several strategies throughout a 15-month randomized controlled trial to encourage retention among a diverse sample of adults with type 2 diabetes. Participants were randomized to receive mobile health support for diabetes self-care for 12 months or an attention control. Participants completed assessments at 3, 6, 12, and 15 months post-baseline. We used three main categories of retention strategies: flexibility in participation (e.g., multiple methods for data collection), communication (e.g., tracking contacts), and community building (e.g., study branding, newsletters). We monitored participants' use of strategies and examined associations between participant characteristics and retention. Results Retention remained high (≥90%) at each follow-up assessment. Participants used various methods for survey completion: online (34%), in-person (31%), and mail (30%). Most (73%) used a mail-in A1c kit at least once. Multiple completion methods were important for retaining minoritized and lower SES participants who completed assessments in-person more frequently. Communication also facilitated retention; 39% of participants used a study Helpline and tracking systems helped maintain contact. Conclusions Retaining disadvantaged patients in clinical trials is necessary so findings generalize to and can benefit these populations. Retention strategies that reduce barriers to participation and engage participants and community partners can be successful. Future studies should assess the impact of retention strategies.
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Affiliation(s)
- Lyndsay A Nelson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Diabetes Translation Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sarah E Williamson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA; DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Knoxville, TN, USA
| | - Lauren M LeStourgeon
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lindsay S Mayberry
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Diabetes Translation Research, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA.
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Newmark J, Gebara MA, Aizenstein H, Karp JF. Engaging in Late-Life Mental Health Research: a Narrative Review of Challenges to Participation. ACTA ACUST UNITED AC 2020; 7:317-336. [PMID: 32837830 PMCID: PMC7242610 DOI: 10.1007/s40501-020-00217-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Purpose of review This narrative review seeks to ascertain the challenges older patients face with participation in mental health clinical research studies and suggests creative strategies to minimize these obstacles. Recent findings Challenges to older adults’ engagement in mental health research include practical, institutional, and collaboration-related barriers applicable to all clinical trials as well as more personal, cultural, and age-related patient barriers specific to geriatric mental health research. Universal research challenges include (1) institutional barriers of lack of funding and researchers, inter-researcher conflict, and sampling bias; (2) collaboration-related barriers involving miscommunication and clinician concerns; and (3) practical patient barriers such as scheduling issues, financial constraints, and transportation difficulties. Challenges unique to geriatric mental health research include (1) personal barriers such as no perceived need for treatment, prior negative experience, and mistrust of mental health research; (2) cultural barriers involving stigma and lack of bilingual or culturally matched staff; and (3) chronic medical issues and concerns about capacity. Summary Proposed solutions to these barriers include increased programmatic focus on and funding of geriatric psychiatry research grants, meeting with clinical staff to clarify study protocols and eligibility criteria, and offering transportation for participants. To minimize stigma and mistrust of psychiatric research, studies should devise community outreach efforts, employ culturally competent bilingual staff, and provide patient and family education about the study and general information about promoting mental health.
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Affiliation(s)
- Jordyn Newmark
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara St, Bellefield Towers 726, Pittsburgh, PA 15213 USA
| | - Marie Anne Gebara
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara St, Bellefield Towers 726, Pittsburgh, PA 15213 USA
| | - Howard Aizenstein
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara St, Bellefield Towers 726, Pittsburgh, PA 15213 USA
| | - Jordan F Karp
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara St, Bellefield Towers 726, Pittsburgh, PA 15213 USA.,Center for Interventions to Enhance Community Health, University of Pittsburgh, Pittsburgh, USA
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Huang B, De Vore D, Chirinos C, Wolf J, Low D, Willard-Grace R, Tsao S, Garvey C, Donesky D, Su G, Thom DH. Strategies for recruitment and retention of underrepresented populations with chronic obstructive pulmonary disease for a clinical trial. BMC Med Res Methodol 2019; 19:39. [PMID: 30791871 PMCID: PMC6385381 DOI: 10.1186/s12874-019-0679-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 02/14/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Recruitment and retention are two significant barriers in research, particularly for historically underrepresented groups, including racial and ethnic minorities, patients who are low-income, or people with substance use or mental health issues. Chronic obstructive pulmonary disease (COPD) is the third leading cause of death and disproportionately affects many underrepresented groups. The lack of representation of these groups in research limits the generalizability and applicability of clinical research and results. In this paper we describe our experience and rates of recruitment and retention of underrepresented groups for the Aides in Respiration (AIR) COPD Health Coaching Study. METHODS A priori design strategies included minimizing exclusion criteria, including patients in the study process, establishing partnerships with the community clinics, and ensuring that the health coaching intervention was flexible enough to accommodate patient needs. RESULTS Challenges to recruitment included lack of spirometric data in patient records, space constraints at the clinic sites, barriers to patient access to clinic sites, lack of current patient contact information and poor patient health. Of 282 patients identified as eligible, 192 (68%) were enrolled in the study and 158 (82%) completed the study. Race, gender, educational attainment, severity of disease, health literacy, and clinic site were not associated with recruitment or retention. However, older patients were less likely to enroll in the study and patients who used home oxygen or had more than one hospitalization during the study period were less likely to complete the study. Three key strategies to maximize recruitment and retention were identified during the study: incorporating the patient perspective, partnering with the community clinics, and building patient rapport. CONCLUSIONS While the AIR study included design features to maximize the recruitment and retention of patients from underrepresented groups, additional challenges were encountered and responded to during the study. We also identified three key strategies recommended for future studies of COPD and similar conditions. Incorporating the approaches described into future studies may increase participation rates from underrepresented groups, providing results that can be more accurately applied to patients who carry a disparate burden of disease. TRIAL REGISTRATION This trial was registered at ClinicalTrial.gov at identifier NCT02234284 on August 12, 2014. Descriptor number: 2.9 Racial, ethnic, or social disparities in lung disease and treatment.
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Affiliation(s)
- Beatrice Huang
- Department of Family and Community Medicine, University of California San Francisco, 995 Potrero Avenue, Building 80, Ward 83, San Francisco, CA 94110 USA
| | - Denise De Vore
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA USA
| | - Chris Chirinos
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA USA
| | - Jessica Wolf
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA USA
| | - Devon Low
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA USA
| | - Rachel Willard-Grace
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA USA
| | - Stephanie Tsao
- San Francisco Department of Public Health, San Francisco, CA USA
| | - Chris Garvey
- University of California San Francisco at Mount Zion Sleep Disorders Center, San Francisco, CA USA
| | - Doranne Donesky
- Department of Physiological Nursing, University of California San Francisco, San Francisco, CA USA
| | - George Su
- Department of Medicine: Pulmonology, Critical Care, Allergy and Sleep Medicine Program, University of California San Francisco, San Francisco, CA USA
| | - David H. Thom
- Department of Medicine, Division of Primary Care and Population Health, Stanford University, Palo Alto, CA USA
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Akinhanmi MO, Biernacka JM, Strakowski SM, McElroy SL, Balls Berry JE, Merikangas KR, Assari S, McInnis MG, Schulze TG, LeBoyer M, Tamminga C, Patten C, Frye MA. Racial disparities in bipolar disorder treatment and research: a call to action. Bipolar Disord 2018; 20. [PMID: 29527766 PMCID: PMC6175457 DOI: 10.1111/bdi.12638] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Health disparities between individuals of African and European ancestry are well documented. The disparities in bipolar disorder may be driven by racial bias superimposed on established factors contributing to misdiagnosis, including: evolving empirically based diagnostic criteria (International Classification of Diseases [ICD], Research Diagnostic Criteria [RDC] and Diagnostic and Statistical Manual [DSM]), multiple symptom domains (i.e. mania, depression and psychosis), and multimodal medical and additional psychiatric comorbidity. METHODS For this paper, we reviewed the phenomenological differences between bipolar individuals of African and European ancestry in the context of diagnostic criteria and clinical factors that may contribute to a potential racial bias. RESULTS Published data show that bipolar persons of African ancestry, compared with bipolar persons of non-African ancestry, are more often misdiagnosed with a disease other than bipolar disorder (i.e. schizophrenia). Additionally, studies show that there are disparities in recruiting patients of African ancestry to participate in important genomic studies. This gap in biological research in this underrepresented minority may represent a missed opportunity to address potential racial differences in the risk and course of bipolar illness. CONCLUSION A concerted effort by the research community to increase inclusion of diverse persons in studies of bipolar disorder through community engagement may facilitate fully addressing these diagnostic and treatment disparities in bipolar individuals of African ancestry.
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Affiliation(s)
- Margaret O Akinhanmi
- Clinical and Translational ScienceMayo Clinic Graduate School of Biomedical SciencesRochesterMNUSA
| | - Joanna M Biernacka
- Division of Biomedical Statistics and InformaticsMayo ClinicRochesterMNUSA,Department of Psychiatry & PsychologyMayo ClinicRochesterMNUSA
| | - Stephen M Strakowski
- Department of PsychiatryDell Medical SchoolThe University of Texas at AustinAustinTXUSA
| | - Susan L McElroy
- Lindner Center of HOPEMasonOHUSA,Department of Psychiatry and Behavioral NeuroscienceUniversity of Cincinnati College of MedicineCincinnatiOHUSA
| | - Joyce E Balls Berry
- Mayo Clinic Center for Clinical & Translational Science (CCaTS)RochesterMNUSA,Department of Health Sciences ResearchMayo ClinicRochesterMNUSA
| | | | - Shervin Assari
- Department of PsychiatryUniversity of MichiganAnn ArborMIUSA
| | | | - Thomas G Schulze
- Institute of Psychiatric Phenomics and Genomics (IPPG)University HospitalLMUMunichGermany
| | - Marion LeBoyer
- Department of PsychiatryMondor HospitalUniversité Paris Est, AP‐HPCréteil, ParisFrance,Inser U955Institute for Biomedical Research Faculté de MédecineCréteil, Paris France
| | - Carol Tamminga
- Southwestern Department of PsychiatryUniversity of TexasDallasTXUSA
| | - Christi Patten
- Department of Psychiatry & PsychologyMayo ClinicRochesterMNUSA,Mayo Clinic Center for Clinical & Translational Science (CCaTS)RochesterMNUSA
| | - Mark A Frye
- Department of Psychiatry & PsychologyMayo ClinicRochesterMNUSA
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Use of a Systematic Consultation Process to Facilitate Nursing Research Projects: An Exemplar. CLIN NURSE SPEC 2018; 32:249-259. [PMID: 30095524 DOI: 10.1097/nur.0000000000000396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE/OBJECTIVES The purpose of this article is to describe the use of a well-established, 5-stage consultation process, to advise a research team on planning strategies to engage domestic violence shelters (DVSs) as community partners in their study. The research team is testing a health promotion intervention for teens living in shelters with their parent and needed to enlist shelters as sites to recruit teens and conduct the intervention. Consultation aims were to (a) identify highly promising strategies described in peer-reviewed literature for identifying, recruiting, and collaborating with community organizations in research and (b) identify DVSs that would potentially serve as effective community partners for the study. METHODS A clinical nurse specialist and a public health master's degree student led the consultation. The consultation process included (a) a systematic review of 29 peer-reviewed articles about research or program evaluation studies that engaged community partners and (b) a comprehensive online search of information about DVSs. OUTCOMES Consultants identified 104 strategies used in studies to engage community partners and 10 specific DVSs most likely to effectively engage in the study. CONCLUSION Clinical nurse specialists are well situated to provide consultation to research teams and should follow well-established consultation processes and systematic data collection procedures.
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Busch AB, He Y, Zelevinsky K, O'Malley AJ. Predicting Participation in Psychiatric Randomized Controlled Trials: Insights From the STEP-BD. Psychiatr Serv 2015; 66:817-23. [PMID: 25828873 PMCID: PMC4888778 DOI: 10.1176/appi.ps.201300557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Differences between patients who do and do not participate in randomized controlled trials (RCTs) could diminish the generalizability of results. This study examined whether RCT participants differ from non-RCT participants who are recruited from the same patient and provider population. METHODS The Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) was an observational study in which participants also could enroll in an RCT during exacerbations of acute depression. The odds that a patient was enrolled in the STEP-BD acute depression RCTs (pharmacotherapy or psychotherapy) were estimated by fitting logistic regression models to STEP-BD participants with acute bipolar depression (total N=2,222; RCT, N=413; observational arm, N=1,809). Predictor variables included demographic characteristics, clinical information (including severity scales and comorbidities), and study site. The extent to which site determined RCT participation was estimated by using the area under the receiver operating characteristic curve (AUC). RESULTS RCT participation was associated with having no insurance (odds ratio [OR]=1.58, 95% confidence interval [CI]=1.16-2.15), a Clinical Global Impression score indicating greater severity (severe versus mild: OR=1.52, CI=1.08-2.15), and site (predicted probability range 8%-31%). Site was the most significant predictor of RCT enrollment (model excluding site, AUC=.61, CI=.58-.64; full model, AUC=.70, CI=.67-.73). CONCLUSIONS STEP-BD RCT participants differed from those in the observational arm in few clinical or demographic characteristics. Site was the strongest predictor of RCT participation. Future study is needed to understand site characteristics associated with RCT participation and whether these characteristics are associated with patient outcomes and to test these findings in usual-care settings.
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Affiliation(s)
- Alisa B Busch
- Dr. Busch and Ms. Zelevinsky are with the Department of Health Care Policy, Harvard Medical School, Boston (e-mail: ), where Dr. He was affiliated when this work was done. Dr. Busch is also with McLean Hospital, Belmont, Massachusetts. Dr. He is now with the Office of Research and Methodology, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland. Dr. O'Malley is with the Dartmouth Institute of Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire
| | - Yulei He
- Dr. Busch and Ms. Zelevinsky are with the Department of Health Care Policy, Harvard Medical School, Boston (e-mail: ), where Dr. He was affiliated when this work was done. Dr. Busch is also with McLean Hospital, Belmont, Massachusetts. Dr. He is now with the Office of Research and Methodology, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland. Dr. O'Malley is with the Dartmouth Institute of Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire
| | - Katya Zelevinsky
- Dr. Busch and Ms. Zelevinsky are with the Department of Health Care Policy, Harvard Medical School, Boston (e-mail: ), where Dr. He was affiliated when this work was done. Dr. Busch is also with McLean Hospital, Belmont, Massachusetts. Dr. He is now with the Office of Research and Methodology, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland. Dr. O'Malley is with the Dartmouth Institute of Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire
| | - Alistair J O'Malley
- Dr. Busch and Ms. Zelevinsky are with the Department of Health Care Policy, Harvard Medical School, Boston (e-mail: ), where Dr. He was affiliated when this work was done. Dr. Busch is also with McLean Hospital, Belmont, Massachusetts. Dr. He is now with the Office of Research and Methodology, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland. Dr. O'Malley is with the Dartmouth Institute of Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire
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Arnold JG, Salcedo S, Ketter TA, Calabrese JR, Rabideau DJ, Nierenberg AA, Bazan M, Leon AC, Friedman ES, Iosifescu D, Sylvia LG, Ostacher M, Thase M, Reilly-Harrington NA, Bowden CL. An exploratory study of responses to low-dose lithium in African Americans and Hispanics. J Affect Disord 2015; 178:224-8. [PMID: 25827507 PMCID: PMC4397978 DOI: 10.1016/j.jad.2015.02.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 02/19/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Few prospective studies examine the impact of ethnicity or race on outcomes with lithium for bipolar disorder. This exploratory study examines differences in lithium response and treatment outcomes in Hispanics, African Americans, and non-Hispanic whites with bipolar disorder in the Lithium Treatment Moderate Dose Use Study (LiTMUS). METHODS LiTMUS was a six-site randomized controlled trial of low-dose lithium added to optimized treatment (OPT; personalized, evidence-based pharmacotherapy) vs. OPT alone in outpatients with bipolar disorder. Of 283 participants, 47 African Americans, 39 Hispanics, and 175 non-Hispanic whites were examined. We predicted minority groups would have more negative medication attitudes and higher attrition rates, but better clinical outcomes. RESULTS African Americans in the lithium group improved more on depression and life functioning compared to whites over the 6 month study. African Americans in the OPT only group had marginal improvement on depression symptoms. For Hispanics, satisfaction with life did not significantly improve in the OPT only group, in contrast to whites and African Americans who improved over time on all measures. Attitudes toward medications did not differ across ethnic/racial groups. CONCLUSIONS African Americans show some greater improvements with lithium than non-Hispanic whites, and Hispanics showed more consistent improvements in the lithium group. The impact of low-dose lithium should be studied in a larger sample as there may be particular benefit for African Americans and Hispanics. Given that the control group (regardless of ethnicity/race) had significant improvements, optimized treatment may be beneficial for any ethnic group.
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Affiliation(s)
| | - Stephanie Salcedo
- Massachusetts General Hospital - Bipolar Clinic and Research Program
| | | | | | | | | | - Melissa Bazan
- University of Texas Health Science Center San Antonio
| | - Andrew C. Leon
- Massachusetts General Hospital - Bipolar Clinic and Research Program
| | | | | | - Louisa G. Sylvia
- Massachusetts General Hospital - Bipolar Clinic and Research Program
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Concannon TW, Fuster M, Saunders T, Patel K, Wong JB, Leslie LK, Lau J. A systematic review of stakeholder engagement in comparative effectiveness and patient-centered outcomes research. J Gen Intern Med 2014; 29:1692-701. [PMID: 24893581 PMCID: PMC4242886 DOI: 10.1007/s11606-014-2878-x] [Citation(s) in RCA: 300] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Revised: 01/16/2014] [Accepted: 04/19/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We conducted a review of the peer-reviewed literature since 2003 to catalogue reported methods of stakeholder engagement in comparative effectiveness research and patient-centered outcomes research. METHODS AND RESULTS We worked with stakeholders before, during and after the review was conducted to: define the primary and key research questions; conduct the literature search; screen titles, abstracts and articles; abstract data from the articles; and analyze the data. The literature search yielded 2,062 abstracts. The review was conducted on 70 articles that reported on stakeholder engagement in individual research projects or programs. FINDINGS Reports of stakeholder engagement are highly variable in content and quality. We found frequent engagement with patients, modestly frequent engagement with clinicians, and infrequent engagement with stakeholders in other key decision-making groups across the healthcare system. Stakeholder engagement was more common in earlier (prioritization) than in later (implementation and dissemination) stages of research. The roles and activities of stakeholders were highly variable across research and program reports. RECOMMENDATIONS To improve on the quality and content of reporting, we developed a 7-Item Stakeholder Engagement Reporting Questionnaire. We recommend three directions for future research: 1) descriptive research on stakeholder-engagement in research; 2) evaluative research on the impact of stakeholder engagement on the relevance, transparency and adoption of research; and 3) development and validation of tools that can be used to support stakeholder engagement in future work.
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Accurately predicting bipolar disorder mood outcomes: implications for the use of electronic databases. Med Care 2012; 50:311-9. [PMID: 22210540 DOI: 10.1097/mlr.0b013e3182422aec] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Monitoring mental health treatment outcomes for populations requires an understanding as to which patient information is needed in electronic format and is feasible to obtain in routine care. OBJECTIVE To examine whether bipolar disorder outcomes can be accurately predicted and how much clinical detail is needed to do so. RESEARCH DESIGN, DATA SOURCES, AND PARTICIPANTS: Longitudinal study of bipolar disorder patients treated during 2000 to 2004 in the 19-site Systematic Treatment Enhancement Program for Bipolar Disorder observational study arm (N=3168). Clinical data were obtained at baseline and quarterly for over 1 year. We fit a "gold standard" longitudinal random-effects regression model using a detailed clinical information and estimated the area under the receiver operating characteristic curve (AUC) to predict accuracy using a validation sample. The model was then modified to include patient characteristics feasible in routinely collected electronic data (eg, administrative data). We compared the AUCs for the "limited-detail" and gold standard models, testing for differences between the AUCs using the validation sample. MEASURE Remission, defined as Montgomery-Asberg Depression Rating Scale score <5 and Young Mania Rating Scale score <4. RESULTS The gold standard models had baseline AUC=0.80 (95% confidence interval=0.74 to 0.86) and 0.75(0.64 to 0.86) at 1-year follow-up. The predicted accuracies of the limited-detail model were lower at baseline [AUC=0.67(0.60 to 0.75)]; correlated test χ=14.25, P=0.002] and not statistically different from the gold standard model at 1 year [AUC=0.67(0.54-0.80); correlated test χ=2.88, P=0.090]. CONCLUSIONS Future work is needed to develop clinically accurate and feasible models to predict bipolar disorder outcomes. Clinically detailed and limited models performed similarly for shorter-term prediction at 1-year; however, there is room for improvement in prediction accuracy.
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Ditmore MH, Allman D. 'Who is Helsinki?' Sex workers advise improving communication for good participatory practice in clinical trials. HEALTH EDUCATION RESEARCH 2011; 26:466-475. [PMID: 21263066 PMCID: PMC3099186 DOI: 10.1093/her/cyq087] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Accepted: 12/11/2010] [Indexed: 05/30/2023]
Abstract
After premature closures in 2004 of biomedical human immunodeficiency virus (HIV) prevention trials involving sex workers in Africa and Asia, the Joint United Nations Programme on HIV/AIDS (UNAIDS) and Global Advocacy for HIV Prevention (AVAC) undertook consultations to establish better participatory guidelines for such trials in order to address ethical concerns. This study investigated sex workers' knowledge and beliefs about research ethics and good participatory practices (GPP) and the perspectives of sex workers on research participation. A 33-question survey based on criteria identified by UNAIDS and AVAC was translated into three other languages. Participants were recruited through mailing lists and contacts with existing sex work networks. In total, 74 responses from Europe, the Americas and Asia were received. Thirty percent of respondents reported first-hand involvement in biomedical HIV prevention trials. Seventy percent indicated a lack of familiarity with codes of ethics for research. This paper focuses exclusively on communication issues described in survey responses. Communication was an important theme: the absence of clear communication between trial participants and investigators contributed to premature trial closures in at least two sites. Sex workers had recommendations for how researchers might implement GPP through improved communication, including consultation at the outset of planning, explaining procedures in non-technical terms and establishing clear channels for feedback from participants.
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